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    Risk Adjustment Specialist - New York, United States - SpeedUpMyJobSearch

    SpeedUpMyJobSearch
    SpeedUpMyJobSearch New York, United States

    3 weeks ago

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    Description

    Location Garden City, NY

    Remote Available **Role: Risk Adjustment Specialist**

    **Location: Garden City, NY (Hybrid-Remote)**

    **Salary: $90,000 - $110,000**

    **JOB SUMMARY:**

    Risk Adjustment Specialist will be highly engaged, self-motivated, enthusiastic and service-oriented team member who will assist our network of primary care providers in identifying and resolving gaps in clinical documentation. The ability to work in a fast-paced environment while working with other teams as you continue to provide better health to countless numbers of patients.

    **ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES:**

    Daily responsibilities include but are not limited to:

    Work with third party vendor to maintain risk adjustment processes

    Support activities to identify risk adjustment strategies and tactics, and then to implement the activity sets (Medicare, Medicaid, Exchange, and Commercial)

    Assist with developing and delivering internal and external educational materials (including provider facing materials)

    Work with claims, enrollment and Medicare teams to resolve data submission errors from Encounter Data Processing System (EDPS)

    Review pended chart requests from vendor and work both internally and externally to assist in facilitating the retrieval of charts

    Assist in developing Risk Adjustment Data Validation (RADV) audit procedures and provide support in a RADV audit

    Assist in developing monthly and ad-hoc reports on risk adjustment project status, both financial and operational in nature

    Assist in developing Risk Adjustment departmental policies and procedures to support Risk Adjustment

    Understand and adhere to all Risk Adjustment regulations and deadlines set forth by CMS

    Perform monthly reconciliation of CMS File rejections

    Communicate and collaborate with medical coding team regarding risk adjustment projects

    Organize and complete internal projects related to risk adjustment coding and accuracy

    Assist in the development of provider risk adjustment training materials

    Perform other duties as assigned

    **QUALIFICATION REQUIREMENTS:**

    Skills, Knowledge, Abilities:

    Experience in using PC-based software packages, including relational database systems, spreadsheets, word processing

    Basic understanding of Medicare payment methodology

    Knowledge of various CMS and NYSDOH reports including:

    MMR, MOR, RAPS Return, EDPS, Plan payment reports

    3M Medicaid reporting

    Excellent analytical skills

    Excellent written and oral communication skills

    Highly proficient with computer skills including working knowledge of Microsoft Office

    Highly organized

    Ability to deal with multiple internal and external resources

    Ability to handle tight timeframes and to meet multiple deadlines

    **Training/Education:**

    Bachelors Degree preferred, High School Diploma required.

    **Experience:**

    1-2 years experience in a healthcare setting

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